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Kelsi Weakley, BHS, RDMS, RVT

Perinatal Sonographer
Regional One Health Maternal Fetal Medicine,
Memphis, TN
 Objectives
• Review commonly used obstetric
measurements and how they are properly
obtained
• Discuss the clinical significance of each
measurement and their parameters.
• Review sonographic images to demonstrate
the discussed measurements and ultrasound
technique to obtain them.
 Dating Terms
• Gestational age (GA): conception date +2
weeks
• Conceptional age: time since the date of
conception
• Estimated Due Date (EDD): date when the
gestational age reaches 40 weeks
 Early First Trimester
• Gestational sac : visible transvaginally at 5
weeks’ gestation
• Yolk Sac: 1st identifiable structure within the
gestational sac
– Visible at 5.5 weeks through first trimester
• Embryo – visible at 6 weeks adjacent to yolk
sac
 First Trimester: Mean Sac
Diameter
Mean Sac Diameter Gestational Age
(mm) (Weeks)*
2 5.0
3 5.1
4 5.2
5 5.4
6 5.5
7 5.6
8 5.7
9 5.9
10 6.0

Table 6-1 Callen Gestational Dating by Mean Sac Gestational sac measured in three planes to obtain the
Diameter in the Early First Trimester Gestational Sac Mean
Yolk Sac
 Crown Rump Length (CRL)
• Most accurate way to assign gestational age
once fetal pole is visualized
• Measured from top of the head to the bottom
of the rump
• Gestational age based on millimeter value
obtained compared to published tables
• 95% confidence range ±0.5 weeks
Crown Rump Length
 Nuchal Translucency
• Gestational age dependent
– Reliable from 11-14 weeks gestation
• Sonographic tool for first trimester
aneuploidy screening
• Specific landmarks/scenarios needed to
accurately obtain
 Nuchal Translucency
• Image magnified 75% showing fetal head,
neck and upper thorax
• Midsagittal plane
• Neutral position
• Amnion visible
• Proper caliper placement
Nuchal Translucency
 Second/Third Trimester
• Measurements of specific fetal parts
individual or combined can determine GA
– BPD, OFD, HC, AD, AC, and FL
• Can identify growth specific abnormalities,
conditions, etc.
 Second/Third Trimester
Head Measurements
• BPD, HC and OFD are obtained axial on the
fetal head
– Thalami
– Third Ventricle
– Cavum Septum Pellucidum (CSP)
• Calvarium and intracranial contents are
symmetrical to either side of the midline falx
Biparietal Diameter
Head Circumference
Occipitofrontal Diameter
 Abdominal Measurements
• Abdominal Diameter (AD)
• Abdominal Circumference (AC)
– Level of the Stomach
– Intrahepatic portion of the umbilical vein
• “J-loop”
• Includes skin line of abdomen
Abdominal Circumference

Callen Figure 6-7 Demonstrating anatomy at the

level of the appropriate AC measurements
Abdominal Circumference
 Femur/Humerus Length
• Measurement of the femoral diaphysis
– Epiphysis not ossified in most of pregnancy
• Perpendicular to the ultrasound beam
• Short Femur or Humerus can indicate
aneuploidy or skeletal dysplasia
Femur Length
Humerus Length
 Second/Third Gestational Age
• Can be assigned based on a single
measurement of a combination with
composite age formulas
• As pregnancy progresses, accuracy
decreases
 Estimated Fetal Weight (EFW)
• Estimated using a formula based on fetal
measurements
• Numerous formulas
• Hadlock (1985) formula most widely used
• Weight percentile used to assess expected
EFW to the norm for gestational age
 Estimated Fetal Weight (EFW)
• Normal range (10-90th percentile for GA)
• Abnormally low (<10th percentile for GA)
– Small for gestational age, Fetal Growth
Restriction
• Abnormally high (<90th percentile for GA)
– Large for gestational age, Macrosomia
 Amniotic Fluid
• Surrounds fetus
• Provides protection from trauma
• Water source
• Allows fetal movement
• Development of fetal lungs
 Amniotic Fluid Volume
• Commonly estimated using ultrasound
techniques
– Amniotic Fluid Index (AFI)
– Maximum Vertical Pocket (MVP)
– Two-diameter pocket
– Subjective assessment
 Amniotic Fluid Index (AFI)
• Abdomen divided into four quadrants
• Patient supine
• Transducer perpendicular to the floor
• MVP measured in each quadrant
– Q1 + Q2 + Q3 + Q4 = AFI
 AFI Quadrants

Callen Figure 20-3 Diagram of the division of

Sonographic demonstration of AFI
the uterus into four quadrants for AFI
Maximum Vertical Pocket (MVP)
• Widely used tool for AFV assessment
• Utilized in twin pregnancies
• Largest vertical pocket ≥ 1cm in width
 Polyhydramnios
• Total volume >2000mL
• Above the 95th percentile for gestational age
• MVP ≥ 8cm
• AFI ≥ 24cm
• AFI > 25cm
• Subjectively high
 Oligohydramnios
• Total volume < 200mL
• Total volume <500mL
• Below the 5th percentile for gestational age
• MVP <2cm
• AFI < 5cm
• Subjectively low
 References
1. Gabbe, S.G., Niebyl, J.R., Obstetrics: Normal and Problem Pregnancies,
Sixth Edition. Philadelphia, PA: Elsevier.
2. Norton, M.E., Scoutt, L.M., & Feldstein, V.A. (2017). Callen’s
Ultrasonography in Obstetrics and Gynecology, Sixth Edition. Philadelphia,
PA: Elsevier.
3. Woodward, P.J., Kennedy, A., Sohaey, R., Byrne, J.L.B., Oh, K.Y., &
Puchalski, M.D. (2016). Diagnostic Imaging Obstetrics, Third Edition.
Philadelphia, PA: Elsevier.